An in-Depth Look at High-Functioning Depression

November 26, 2020


What is high functioning depression? High-functioning depression is an insidious mental condition that affects millions of people across the globe. The disorder is almost indiscernible, and therefore, you can never tell that someone is battling with it by merely looking at his/her face. High-functioning depression is complicated and affects ordinary-looking people, including lawyers, doctors, and teachers. You could also be one among the millions of Americans who are battling high-functioning depression without knowing it.

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At this point, you’re probably wondering what exactly this disorder is, and how it feels to battle an invisible mental disorder. Well, you’re not alone. If you don’t know about high-functioning depression or want to learn more about this disorder, worry no more. We are here to make things more apparent to you.

In this guide, we’re going to take a closer look at high-functioning depression. We will explain in detail what it’s all about. To achieve this, we will go beyond the basic definitions and symptoms of the disorder. So, let’s dive right into it!


1. High-Functioning Depression, Beyond the Definitions

When defining what high-function depression is, one needs to look beyond medical definitions. Think of a woman who does a great job managing her household and can also undertake her tasks at work successfully. She might appear to be happily married, a successful career woman, and an intelligent person to everyone else. However, that’s what people see from the outside.

In reality, the woman could be the most miserable person, totally unable to find happiness for herself or derive satisfaction from others. Those around her might never realize her unhappiness because she’s battling high-functioning depression.

That example brings out our definition of high-functioning depression (HFD).

Mental health professionals point out that HFD is a state of mind where the disorder doesn’t affect an individual’s functional ability or the abilities that he/she is capable of. This explains why the illness isn’t intense enough to disrupt an individual’s on-job performance in most cases. High-functioning depression also has other aspects to it, which we will cover later on in this guide.

For now, let’s learn more about HFD.

The term high-functioning depression implies that an individual can still function normally even when battling the disorder. Typically, depressive symptoms don’t manifest themselves physically or affect an individual in his/her daily life activities. Somewhat, nothing gets disrupted in an individual’s life since the condition often occurs insidiously.

HFD is commonly confused with another depressive disorder called dysthymia. Although the two disorders have similar characteristics, they differ.

Dysthymia is a long-term depression, which also tends to be chronic. The condition is also disruptive and persistent. It causes patients to lose interest in their work and their daily activities.


Dysthymia is also known as persistent depressive disorder.


What Makes HFD Different from Dysthymia?

When battling a mental illness, a typical American will use several vague terms to describe his/her symptoms. This explains why other similar disorders tend to overlap with the one that an individual is battling in most cases.

Many people confuse HFD with dysthymia. Health experts have also contributed significantly to this confusion since many of them claim that dysthymia is a pop term for HFD in current times. Others contradict this idea.

Despite sharing many similarities, there’s no concrete evidence to conclude that there’s a correlation between HFD and dysthymia.

But, what makes HFD an invisible disorder?

The primary reason why HFD is an invisible disorder is that doctors can’t diagnose it. Diagnosis only happens when an individual figures out that he/she is experiencing some symptoms and thus decides to seek help from certified health experts to discuss his/her condition openly.

Another reason for referring to HFD as an invisible disorder is that its signs and symptoms are remarkably similar to what you’d experience when battling other mental health conditions. Therefore, it’s challenging to figure out high-functioning disorder through differential diagnosis.

Living with HFD: How Does It Feel?

As we’ve already pointed out, there are no clinical criteria for diagnosing this disorder. This highlights the significance of considering what an individual feels about battling the disorder. In this regard, you should consider these critical parameters for evaluation and diagnosis:

  • You always feel down and low throughout the day. Those around you will notice that you’re quiet and out of energy most of the time. You may also feel tired and gloomy, whether you’re alone or surrounded by others.
  • It’s rare to find happiness, and when you do, it fades away within a short time. Your best moments also tend to turn into sad moments. Low mood and dissatisfaction are part and parcel of your everyday life and are present wherever you go. Your surroundings and everything else happening in your life don’t bring any substantial change in your sentiments and attitude.
  • Your energy levels are always low, and you tend to feel sick and tired of the tasks assigned to you. When undertaking normal daily activities, you feel inactive and physically weak. Getting a good night’s rest doesn’t seem to work in your favor because it doesn’t make any difference as far as your motivation and energy levels are concerned.
  • At times, you don’t feel lazy, yet your activities and energy levels are restricted to tasks that are necessary for survival. You lack the impetus to undertake extra work.
  • You keep downgrading your achievements and abilities all the time. You think of yourself as undeserving of the happiness and finer things that life offers. As a result, you think you’re destined to get nothing in life because you’re unworthy of the good thing that might come your way.
  • You find it difficult to balance your taste. You either have a ravenous appetite, or it disappears altogether. At times, you binge eat and then find yourself missing meals. This often results in sudden and unintentional weight gain or loss.
  • You don’t have a prominent or valid reason, but sometimes, you get emotional and assume the worst outcomes of real and perceived problems.
  • Completing tasks isn’t an issue, but you find it difficult to focus on the tasks.
  • You push yourself hard to interact and socialize with others or even attend social gatherings. You tend to miss out even on family functions because of the urge to withdraw from crowds.

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2. Clinical Signs and Triggers of HFD – How to Overcome Loneliness?

In this section, we are going to take a look at the common symptoms of the high-functioning disorder and the things/situations that trigger this condition. Therefore, this chapter is of great significance to those who are battling the disorder.

By now, you probably know that HFD can easily fly under the radar and remain invisible even to those who are closest to you. Not even your friends and family members may notice that you’re struggling with a mental health issue. That applies to you too!

Signs of HFD

As a patient, you should be able to recognize come significant signs of the disorder, including:

  • Lack of interest in daily activities
  • The tendency to seek perfection in everything, including unimportant things
  • Hopelessness and gloominess
  • Lethargy and general lack of energy
  • Emptiness and feeling low even when things around you are fine
  • Extreme self-criticism and self-judgment
  • Trouble focusing even on the simplest tasks
  • Inability to make decisions
  • Impulsivity and short temper
  • Notable decrease in productivity
  • Being resistant towards socializing
  • Poor appetite or binge-eating habits
  • Feeling unworthy and guilty over things you can’t control
  • Sleep disorders and insomnia
  • Suicidal thoughts

When suffering from other mental health disorders, patients tend to feel captivated by their condition. As a result, it’s difficult for them to get over their symptoms. This isn’t the case with HFD because symptoms of the disorder tend to be less severe. Therefore, patients can easily manage their condition by figuring out coping strategies that work best for them.

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Are There Proven Criteria for Diagnosing HFD Symptoms?

There’s a definite set of criteria used to distinguish mental health conditions from each other to attain the final diagnosis. However, the same cannot be said for high-functioning depression since the condition doesn’t have an authentic criterion for diagnosing its symptoms. The symptoms don’t show, and there’s also a notable contradiction on whether to establish a separate benchmark for distinguishing HFD from dysthymia.

Some notable symptoms of HFD are a fundamental component of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Most of the symptoms that we will highlight in this guide are also symptoms of other depressive disorders. Nevertheless, the severity of high-functioning disorder tends to be less than other mental health conditions.

The first criterion for diagnosing HFD is that individuals need to experience a depressive mood for several days for at least two years. Furthermore, depressive behavior should include at least two of these symptoms:

  • Binge eating
  • Poor appetite
  • Low self-esteem
  • Feeling of hopelessness
  • Low energy

Signs of a Major Depressive Episode

Most people who are battling HFD experience a significant depressive disorder more than once in their lives. They often have low depressive symptoms, which typically don’t show up. However, depression in itself can cause a significant depressive episode.

When an individual suffers from a regular mental health disorder, he/she tends to experience severe depressive symptoms. However, this isn’t the case with HFD since it can be easily distinguished from major depressive disorders. HFD can be distinguished from major depressive disorder by two parameters; duration and severity.

A high-functioning disorder affects an individual for a long time. On the other hand, major depressive disorder only stays for a brief period. The two disorders’ symptoms are somewhat similar but may worsen when an individual experiences a depressive episode.

Another distinguishing feature of both disorders is their effect on the level of functioning. It’s understood that although HFD doesn’t affect an individual’s level of functioning, it might affect the level of focus. Nevertheless, it doesn’t affect one’s ability to complete tasks assigned to him/her. Individuals experiencing a major depressive episode tend to start stuttering at task completion, and meeting set deadlines. Some of them may start avoiding embarking on tasks, which forces them to miss out on school or job opportunities. Also, there’s a notable slide in social interaction and self-hygiene.


High Functioning Depression
HFD can be a reason for depressive disorder.


What Triggers High-Functioning Disorder?

Many people think that depression is always triggered by something, but that’s not the case. Here are some of the triggers of high-functioning disorder.

Financial Difficulties

Economic crises and financial difficulties are the leading causes of HFD. People who struggle with complex financial matters are at a higher risk of developing HFD. Such individuals end up being unable to focus even on the simplest of tasks due to their condition.

When financial matters intermingle with someone’s cognitive ability, it becomes difficult to focus and make crucial decisions. When HFD results from financial problems, it significantly affects the brain’s psychomotor functioning.

Extreme Stress Levels

What many people fail to understand is that stress is part and parcel of everyday life. It keeps us going, more so when facing challenging situations. In intense situations, the body needs to be kept in flight and fight mode. You need maximum concentration, focus, and energy to handle such situations, and stress comes in handy. However, extreme stress levels shift the optimal level to a chronic level, thus triggering depression.

When you experience chronic stress constantly, you’re likely to have HFD. The workload and stressors you have may feel normal since they’ve become part of you. However, you won’t realize that these stressors only escalate your HFD even without any symptoms.

Traumatic Events

Human life is characterized by traumas, such as losing our loved ones, accidents, and other bad experiences. Such events often have a longstanding impact on the brain and may lead to HFD in disguise. Typically, HFD is the body’s response to the trauma you have experienced or witnessed. Reactions of depression tend to be short-lived. However, if your reactions don’t go away after years, you’re probably experiencing deep-rooted mental health issues. HFD could be one of them.


It is human nature to love being surrounded by other people, and psychologists attest to that. Being in the company of other people is enjoyable and provides a positive environment that your brain needs to develop. Isolating yourself excessively makes you feel lonely and depressed. It raises your cortisol levels, thus giving the brain the impression that you’re under stress.

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Since human beings are social creatures by nature, alienating yourself from social interactions harms your mental health, and leaves you feeling depressed. You may not notice it because the high-functioning disorder doesn’t affect your work and tasks assigned to you, and neither does it give you peace of mind.

Major Life Changes

Change is an inevitable aspect of human life. Often, the changes that we experience in our lives result in challenging situations that may leave us feeling depressed. A major life change has both negative and positive sides to it. For instance, what would be your reaction if you made a million dollars overnight? Indeed, the emotions will likely be exaggerated, just like the stress that comes with such a change.

Your body reacts to both good and bad extreme situations in a similar psychological pattern. At times, the responses that we have towards major life changes hit us back suddenly, more so when we are mentally unprepared to take them. This often results in high-functioning depression.


3. The Challenges of High-Functioning Depression – Dealing with Loneliness

It’s difficult to understand HFD both as a patient and a healthcare professional. Although this mental health condition doesn’t stipulate the tasks, capabilities, and ambition of an individual, there are a couple of specific challenges related to an individual’s behavior and mood, which affect his/her lifestyle. The characteristics and traits linked to depressive behaviors and thoughts fall into two categories:

  • The clinical challenges of high-functioning depression
  • Challenges faced by individuals battling HFD

1. Challenges Faced By Individuals Battling HFD

Self-Criticism and Doubt

Criticizing yourself or being criticized reasonably is healthy. Nevertheless, nobody likes taking incessant criticism. Individuals who are battling HFD often struggle with extreme self-criticism and like making harsh judgments about themselves. Such criticism only adds more stress to your life and helps to trigger HFD symptoms. In the beginning, it’s easy to calm yourself, despite your doubt and self-criticism. However, this strategy always fails with time.

Often, the criticism ends up taking on a broader shape, more so when you start feeling ashamed of yourself and cornering yourself from society. This explains why most people who have HFD end up alienating themselves from others, thus depriving themselves of the treatment and help they need.

Seeking Self Perfection

Nothing is perfect in life. However, this is something that never registers in the mind of an individual with HFD. There’s a connection between high-functioning depression and perfectionism. Adaptive perfectionism is healthy since it enables you to correct wayward things and organize yourself. The same cannot be said of maladaptive perfectionism since it has a deep-rooted link to HFD.

There are three subcategories of maladaptive perfectionism, which are:

  • Self-oriented perfectionism
  • Other-oriented perfectionism
  • Socially-prescribed perfectionism

To summarize these sub-categories, we could state that maladaptive perfectionism has unrealistic and exaggerated standards that individuals cannot attain. As a result, it becomes difficult for them to accept shortcomings and flaws in themselves and others. This leaves them in a depressive state of mind.


High Functioning Depression
Challenges faced by individuals battling HFD.


Restlessness and Agitation

HFD is among the leading causes of restlessness and agitation. This is an inner feeling of turmoil, which leaves you annoyed. Agitation is caused by:

  • Unease feelings
  • Crankiness
  • Lack of patience
  • Nervousness

Sometimes, agitation turns into aggression, which explains why individuals battling high-functioning depression are usually easily irritated and short-tempered. Often, their brains are racing against their inner thoughts and feelings. This also ends up affecting their sleep patterns. If agitation is caused by a mental health issue such as HFD, it’s important to manage the disorder with a mental health expert’s help.

Social Stigma

Even in today’s modern society, a lot of stigmas is related to mental health issues. Most people who are battling mental health disorders such as high-functioning disorders can’t speak about it due to the negative views and behaviors that others hold for them.

Patients tend to hide their battle with HFD and thus fail to speak about what they are experiencing due to societal stigma. Even today, many people still believe that individuals who are battling mental health issues lack standard human capabilities. Other myths and misconceptions related to high-functioning disorder will be addressed later on in this guide.

2. Clinical Challenges Faced by HFD Patients

Diagnosing and treating HFD is difficult due to the clinical challenges that mental health experts face. The greatest challenge is distinguishing between high-functioning depression and other mental conditions. HFD symptoms are strikingly similar to most depressive and anxiety disorders, thus making diagnosis difficult.

Despite the advances that have been made in the field of mental health over the past few years, there is no HFD-specific diagnostic criteria. The biggest challenge that mental health experts face is that HFD doesn’t have known clinical criteria for diagnosing it. Health experts only grope in the dark by considering the signs and symptoms that patients are experiencing, besides asking about their complaints.

This makes it difficult to rule out the condition without a doubt. Diagnosis primarily depends on the precision with which a patient describes his/her symptoms to a doctor. The experience of the doctor also goes a long way in enabling him/her to know that it’s a case of HFD and no other mental disorders.

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4. Treatment Options and HFD Coping Methods

Before delving into the available treatment options for HFD and the condition’s coping strategies, it’s essential to understand the significance of treating the disorder.

At this point, you definitely understand that HFD doesn’t affect an individual’s normal functioning. Even so, emphasis should be made on the fact that basic functioning alone isn’t enough for survival. Individuals struggling with HFD often experience a subdued level of depression. Therefore, they live with stress throughout.

Fair treatment is necessary for these individuals’ higher functioning. It also enhances their mood, mental health, and ability to exist harmoniously in society. A fair treatment regimen can suppress most of the complications related to HFD, including:

  • Chronic pain
  • Lack of harmonious relationships
  • Poor performance at work and school
  • Suicidal behaviors and thoughts

Treatment Options for HFD

There are many residential centers that claim to offer treatment for HFD. Most of these facilities provide patients with treatment and coping strategies. Treatment tends to be individualized in the sense that the mechanisms used are selected for each individual case. This is done to ensure compatibility and the best outcome for individual HFD cases.

The treatment strategies and coping mechanisms that you’ll come across are always straightforward and can be used at home after visiting a mental health facility. Moreover, HFD treatment comes with the option of getting treated alone or undergoing group therapy sessions.

Although medication plays a significant role in treating high-functioning disorder, therapy is the number one intervention. Typically, medications come after therapy.

Individual Psychotherapy

As indicated above, HFD patients can either undergo individual or group therapy. Individual therapy is whereby patients are treated alone in one-on-one sessions. This helps to uncover their underlying emotions and feelings. Different negative stressors can also be determined during individual psychotherapy sessions. This treatment method is highly recommended for HFD patients.

Cognitive Behavioral Therapy

Also known as CBT, this form of therapy helps to correct an individual’s thinking patterns and eventual actions. Patients are guided on how to regain their lost confidence and get over their fear of social interaction. Cognitive-behavioral therapy is also widely used to treat HFD and other mental health disorders.

Relational Therapy

Typically, the high-functioning disorder affects an individual’s interpersonal relationships. Relational therapy enables patients to sort out the connections between themselves and their loved ones. It makes them aware of how their thoughts, moods, and behaviors influence their relationships. Ultimately, they use this to ensure that relationships work better for everyone.

Family Therapy

This is an ideal intervention for educating people who are close to you about the high-functioning disorder. Once your family members and loved ones are aware of your situation and the challenges you face, it will be easier to tackle any issues that may arise. Family therapy also goes a long way to eliminating the stigma associated with HFD.


High Functioning Depression
HFD patients can live a stressed life.


Trauma-Focused Therapy

Trauma is among the leading causes of HFD. If a traumatic incident is the underlying cause of your condition, treatment should focus on reshaping memories of that incident. This is what trauma-focused therapies are all about. They concentrate on reframing and processing your past experiences to improve your HFD symptoms and ultimately get over the condition.

Acceptance and Commitment Therapy

This intervention focuses on helping patients to accept their negative thoughts. It teaches them about coping with their negative feelings and emotions better, rather than trying to replace those emotions with worse or vague thoughts and feelings.

Mindfulness and Relaxation Techniques

Holistic and alternative therapies such as relaxation and mindfulness are excellent options for treating high-functioning depression. Meditation, yoga, and other specially designed exercises are used by health experts to help patients.

FDA-Approved Pharmaceutical Therapy

As we highlighted earlier, several pharmaceutical interventions have been advanced to help treat HFD. The commonest pharmaceutical treatments for HFD are:

Selective Serotonin Reuptake Inhibitors (SSRIs)

These drugs are mostly used to treat depressive disorders. They are great at easing out the symptoms of both moderate and severe depressive disorders, including high-functioning disorder. As the name suggests, SSRIs work by increasing the availability of serotonin in the body. This is a neurotransmitter in the brain that optimizes behavior and mood.

Before embarking on medication, it’s best to keep in mind that SSRIs have possible side effects, including:

Sedatives and anxiolytics antidepressants are the other drugs used to treat high-functioning depression.

When using pharmaceutical drugs to treat high-functioning depression, ensure that you take the medications as per the doctor’s prescription and guidance. Also, you should only take FDA-approved medication.

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5. HFD Facts and Suicide Depression Due to Loneliness and Stress

It’s difficult to figure out that a person is battling HFD. This is because patients tend to appear normal to others, but deep inside, they are in a silent battle with this depressive disorder. Here are some probabilities based on acts that an individual with HFD may experience.

If You Feel or Notice that You’Re Pretending to Be Okay

There’s a point in life when you feel like you’re continuously pretending to be fine, yet you’re not. When this happens, you’re likely to keep your struggles to yourself because there’s nothing much to explain about your condition. Gatherings and other social occasions may not work for you because you are sad and hopeless. Your thoughts do nothing to help you get out of this gloomy cloud.

No One Believes You’re Struggling

When battling HFD, you may be able to step out of the house and attend to your chores. You’re even likely to be a successful career person who is envied by other people. No one will believe that you’re struggling behind the scenes.

In your moments of frustration, people may think that you’re faking your emotions or experiencing mere mood swings. Others may think that you either don’t want to work, or you’re running away from tasks and responsibilities.

Typically, high-functioning disorder patients hear mild or harsh comments about themselves due to the difficulty in proving that their condition is just like any other mental health issue. Therefore, it becomes difficult to seek and receive help from others.

Good Days Are Average while Bad Days Are Unbearable

For HFD patients, there’s nothing cheerful about good days. Indeed, he/she may feel just like a typical person, get up early and energized to start off the day, but that’s just it. On the other hand, the not-so-good days tend to be unbearable for high-functioning disorder patients. Right from the moment they wake up, everything feels like hell. On such days, they will wake up feeling drained out of energy, in a bad mood, and unable to focus on and complete tasks at work or school.

On bad days, you should remember that HFD isn’t always the cause for your low energy and bad mood. Undeniably, continuously battling HFD takes a toll on you. However, you should accept that the disorder does not always cause laziness. There could also be other factors that make you a couch potato.

Destructive eating habits, lack of sleep, taking multiple medications for other conditions, and lack of essential nutrients in the body are some of the factors that can make you feel lazy. Therefore, it’s best to ensure that these factors are ruled out by a doctor when diagnosing HFD.


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Mental health affects the way we think, feel and behave.


How and when Should Patients Seek Help?

If you are experiencing any of the HFD symptoms we’ve mentioned, you should seek immediate help from a mental health professional. Just like it’s the case with other disorders, early diagnosis helps to resolve any issues before they worsen.

Once you visit a healthcare facility, your doctor will note down the history of your symptoms before screening you. If he/she determines that you’re battling with a mental health issue, you will be referred to mental health experts.

Medications, therapies, and coping strategies for high-functioning disorder tend to differ from one patient to another.

Suicide Prevention

Many people who are battling mental health issues like high-functioning depression also struggle with suicidal thoughts. Among the possible challenges of battling HFD, suicide is arguably the most dreadful. Therefore, suicidal thoughts should be addressed promptly before patients do any harm to themselves. Here are some warning signs of suicidal behaviors among high-functioning disorder patients:

  • Talking about suicide directly
  • Hopelessness
  • Seeking access to dangerous objects such as guns and poison
  • Self-hatred
  • Writing a will unexpectedly
  • Drastic mood changes
  • Withdrawal from one’s social circle
  • Increased alcohol/drug consumption

To detect suicidal behavior, or if you feel like you’re going off-track, these tips will come in handy:

  • Seek help from a qualified mental health expert
  • Don’t miss out on therapy or follow-up sessions
  • Instill positivity in yourself by adopting a healthy lifestyle
  • Speak positively of yourself and your prospects in life
  • Keep dangerous objects out of reach
  • Maintain ties with friends and family members

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The Road Ahead

Among all the known mental health conditions, the high-functioning disorder doesn’t have a formal and definitive diagnosis. The term ‘high-functioning disorder’ is in itself misleading and can be confused with other prominent physical and mental health conditions.

Anyone who feels depressed should seek help from professionals. Your primary healthcare provider will recommend a mental health expert so that your condition is diagnosed and treated early.

Dealing with depression is energy-sapping, and therefore, you shouldn’t do it alone. You need a supporting cast that will stand by you till the end. Therefore, it’s essential to recognize your symptoms early and seek help from professionals without delay.

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